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Published: 23rd February, 2024


Updated clinical audits: stepping down PPI treatment, aspirin for CVD risk

We regularly add new content to our website – check out the latest resources on our home page reel or search for something specific. Two updated clinical audits have recently been published:

Identifying patients who may benefit from “stepping down” PPI treatment

This audit identifies patients who are prescribed a proton pump inhibitor (PPI), e.g. omeprazole, and documents their management to determine whether the indication for ongoing treatment remains and if they are taking the lowest effective dose.

Click here to view the audit

Reviewing patients taking aspirin for the management of cardiovascular disease risk

This audit identifies patients who are taking aspirin for the primary or secondary prevention of cardiovascular disease to determine if ongoing treatment is indicated. This is based upon guidance in the 2018 New Zealand Cardiovascular Disease Risk Assessment and Management for Primary Care consensus statement which is still in line with more recent international evidence.

Click here to view the audit

Funded catch-up period for Meningococcal B vaccine ends this month

As reported in Bulletin 91, a catch-up programme for the meningococcal B vaccine (Bexsero) has been available since March, 2023, but is soon to conclude. Two doses of Bexsero are currently funded for people aged 13 – 25 years at any year of living in specified close living situations (boarding schools, hostels, university halls of residence, military barracks and youth justice residences or prisons). The catch-up programme ends on 28th February, 2024. Once the meningococcal B catch-up programme ends, only people aged 13 – 25 years currently in their first year of a specified close living situation or who will be moving into communal accommodation within the next three months will be eligible to receive funded meningococcal vaccination with Bexsero and MenQuadfi (for meningococcal ACWY).

The latest data released by the Institute of Environmental Science and Research (ESR) shows an overall decrease in the number of meningococcal cases in 2023 compared to 2022. However, there has been an increase in the number of cases occurring in people aged 15 – 24 years.

New COVID-19 vaccine to be available from 7th March, 2024

The new COVID-19 vaccine, Comirnaty Omicron XBB.1.5, recently approved by Medsafe for people aged 12 years and older (as reported in Bulletin 91) will be available for use from 7th March, 2024. There are currently no changes to COVID-19 vaccine eligibility criteria. For further information on COVID-19 boosters, see Bulletin 90.

The Immunisation Advisory Centre is hosting a webinar discussing the Comirnaty 30 microgram XBB.1.5 vaccine on Tuesday 27th February, 5.30 – 6 pm. Click here to register.

UK strengthens restrictions around fluoroquinolone use

In January, 2024, the United Kingdom Medicines and Healthcare products Regulatory Agency (MHRA) published a new Drug Safety Update on fluoroquinolone antibiotics, e.g. ciprofloxacin, norfloxacin. They can now only be used in the United Kingdom as a last resort when other suitable antibiotics are inappropriate, i.e. due to resistance, contraindications, inadequate response to treatment or adverse effects that require stopping treatment. Previous prescribing restrictions remain in place in the United Kingdom, i.e. fluoroquinolones should not be prescribed for mild to moderate or self-limiting infections, or non-bacterial conditions.

In New Zealand a restrictive approach to fluoroquinolone use is also recommended as community prescribing of these antibiotics contributes significantly to antimicrobial resistance. Ideally, fluoroquinolones should be reserved for serious, life-threatening or difficult-to-treat infections, when other antibiotics cannot be used due to allergy or intolerance, or when the pathogen is resistant to other antimicrobial agents.

For further information on limiting the use of fluoroquinolone antibiotics, see: Also see the bpacnz Antibiotic guide: choices for common infections, here.

Medicine proposals: widening shingles vaccine access, ICS/LAMA/LABA combination inhaler funding

Pharmac has recently released a series of funding proposals for gynaecological cancer, respiratory disorders, infectious diseases and vasculitis. Consultations close 4pm Thursday 29th February, 2024. The following proposals may be of particular interest to primary care:

Medicine supply news: sacubitril with valsartan, omeprazole, oestradiol valerate, bisoprolol, salbutamol, mesalazine, olsalazine

The following news relating to medicine supply, of particular interest to primary care, has recently been announced. Medicine supply information is also available in the New Zealand Formulary at the top of the individual monograph for any affected medicine and summarised here.

A focus on medicine misuse: distinguishing dependence from addiction

The terms “dependence” and “addiction” are often used interchangeably in a clinical setting. However, these classifications describe distinct clinical scenarios; applying them correctly is crucial as it informs the subsequent approach to management.

  • Dependence describes the natural physiological adaptations that can occur in response to repeated dosing of certain medicines, resulting in increasing tolerance and the presence of withdrawal symptoms when the medicine is discontinued. A medicine does not need to induce euphoria or other re-enforcing effects for physical dependence to occur.
  • Addiction (substance use disorder) involves behavioural changes such as compulsive use, craving and impaired control over medicine use, often in addition to physical dependence. A key distinctive feature is that psychological adaptations occurring in people with addiction means they lose control over the intense urges to take a medicine, even when use carries harmful consequences.

Misdiagnosing a patient with dependence as having addiction can result in a cascade of negative effects, including stigma, discontinuation of essential medicines and unnecessary scrutiny of both the patients and clinician. It is important for clinicians to recognise that dependence may occur even when patients take a medicine as prescribed, and the presence of withdrawal symptoms in isolation does not necessary warrant referral to addiction services.

Further insights into the distinction between dependence and addiction is available in a 2023 correspondence published in The Lancet Psychiatry, here, and a commentary published in the Annals of Medicine (2021), here.

Health Status Report 2023 published

Health New Zealand, Te Whatu Ora, has released a report investigating the current health status of people living in New Zealand. The report covers a wide range of health indicators and factors associated with health status, including life expectancy, mortality from long-term conditions, e.g. cardiovascular disease, cancer, exposure to modifiable risk factors, e.g. smoking, body weight, and health care services.

Overall, there are positive trends in the population health of New Zealand, e.g. a 10% reduction in daily smoking rates, however, health disparities remain. Māori and Pacific peoples and people who live in the most deprived areas often have worse health outcomes compared to European/Other groups and people who live in the least deprived areas, e.g. the life expectancy of Māori and Pacific peoples is between six and eight years shorter than European/Other groups. An associated press release, which includes key points, is available here.

Paper of the Week: Early indicators of bipolar disorder in primary care

Bipolar disorder is a chronic psychiatric condition characterised by extreme changes in a person’s mood, energy and ability to function. People with bipolar disorder have an increased risk of cardiovascular, metabolic and neurological conditions, self-harm and suicide, unemployment and alcohol and substance misuse, compared to the general population. Being diagnosed with this condition can significantly impact quality of life and overall life expectancy. Given that bipolar disorder is generally only recognised after a patient experiences an overt episode of mania (or hypomania), diagnosis is often delayed, compounding the negative health and social outcomes.

A study published in the British Journal of General Practice analysed primary care records to identify potential indicators of undiagnosed bipolar disorder. Their findings suggested having certain pre-existing psychiatric conditions (e.g. depression, anxiety disorders, schizophrenia, personality disorders), being prescribed specific medicines (e.g. antidepressants, antipsychotics) or being prescribed more than three psychotropic medicines in one year and having particular patterns of health interactions (e.g. frequent medical consultations, higher rates of missed appointments) may be underlying signals of undiagnosed bipolar disorder. Being aware of these potential early indicators in primary care may facilitate earlier recognition and referral of patients with bipolar disorder to a specialist psychiatry service, thereby improving their quality of life.

Are there any behaviours or signs that you consider potential indicators of specific psychological conditions? Do the conclusions from this study match your experiences with patients who are later diagnosed with bipolar disorder?

Morgan C, Ashcroft DM, Chew-Graham CA, et al. Identifying prior signals of bipolar disorder using primary care electronic health records: a nested case–control study. Br J Gen Pract 2023;:BJGP.2022.0286. doi:10.3399/BJGP.2022.0286

For further information on bipolar disorder in primary care, see

This Bulletin is supported by the South Link Education Trust

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